Female Genital Mutilation Is Big Business

The Guardian published my article on the economics of female genital mutilation (FGM) today, 13 April 2016.
Entitled FGM: a costly, organised crime against women and girls, the article is an attempt to address some of the issues, especially the financial ones, which continue to make the eradication of FGM so difficult, whilst also wasting precious human and economic resources.

This is a more detailed version of my Guardian piece:

Female genital mutilation (FGM) is big business. It’s trans-global and sometimes organised by centuries old formal agencies, on a for-profit basis. Like most other efficient businesses, it markets itself as in the interest of the consumer, into whose life style expectations it is firmly embedded.

These observations imply no disrespect for the immense suffering which FGM causes. They are a stark statement of the truth: across the globe there are probably 200 million women and girls now alive who have experienced (and survived) FGM.

Yet, as Navi Pillay, the United Nations High Commissioner for Human Rights, told a conference in June 2014, economic factors play a significant role in the persistence of FGM. This is true in regard to who does it, why it is done and the impacts it has on the wider economy.

Practitioners are often paid. Until recently nearly all excisors were medically untrained operators following traditional modes of action. Increasingly however, excision is undertaken by qualified clinicians, giving FGM in the eyes of some a veneer of respectability.

Small wonder that the World Health Organisation regards the medicalisation of FGM as the greatest threat to its final eradication. FGM now augments low-paid (or avaricious) medical workers’ incomes, just as it has attracted kudos and power, as well as income, for traditional excisors in communities where other high-status work is hard to come by.

Specifics vary, but senior members of secret organisations such as the Sande Society of Central West Africa (and their male partners, the Poro) will have much to lose if the initiation programmes over which they preside– ‘bush school’, the mutilation itself, ‘coming of age’ ceremonies, bride price negotiations and much else – are no more.

Deeply rooted tradition demands that local girls undergo FGM, and sometimes other harmful traditional practices (‘beading’, breast ironing etc), if they are to gain access to a husband and the adult world. Without FGM they are ‘unclean’; perhaps they will be cast aside from their community. The economic prospects for the girl and her family (no bride price) may be as dire as those of the excisors, if FGM is abandoned.

To prevent FGM, excisors are sometimes offered alternative opportunities for work; goats in return for the knife is one suggested option. Goat farming however provides neither the income, nor the influence or prestige, of the ancient role of excisor – a potential drawback in programmes where harmless ‘alternative rites of passage’ are considered; socio-economic factors may be critical in replacement propositions.

Parallel economic concerns might include the horrors of human/slave trafficking (second only to drugs as global trade) and even body part trafficking. These happen too, sometimes alongside traditions like FGM and child brides.

But it’s not ‘only’ personal finance and local business interests which are integral to FGM. The human and health costs are often great for the girl or woman herself, and for her children. Ten to thirty percent of those who undergo FGM may die from it, either directly because eg of shock, haemorrhage and infection (tetanus, HIV etc), or from other complications: obstetric haemorrhage alone in one study of African countries was estimated to reduce the average life expectancy of the hundreds of thousands of women studied by half a month. Treatment costs would probably be recouped in healthier outcomes.

For the mother, even if she survives, the medical outcomes of FGM can include the living nightmare of obstetric fistula; for the child obstructed delivery is a real risk, with death or the long-term ill-health consequences which that carries. Plus, infants whose mothers die or cannot care for them have a much higher likelihood of dying as well.

And all these factors have financial costs in addition to the massive human ones. As we have seen with the recent Ebola outbreak, where medical care is made available to address one public health peril, resources become unavailable for other less directly inflicted conditions. Where health care is unavailable, women’s much needed contributions to the local economy, of labour and enterprise, are lost.

Then there’s the difficult question of land. In some traditional African communities women own land in their own right. But women who have not had FGM may be refused adult status, and so the land may go back to their menfolk. Instead of becoming modern citizens by refusing mutilation, women may thereby be reduced to the status of chattels.

Movement of people from the land to the city is also significant. Those living in shanty towns generally have worse health (physically and psychologically) than people who live off the land. Research suggests that such un-wellness prevents shanty town new-comers from securing greater comfort as time moves on. FGM surely makes this malady trap even more likely.

And what of the diaspora, when people leave their traditional homeland?

In western societies FGM may itself cause the very outcome it is intended, back ‘home’, to avoid. Girls experiencing FGM in places like the UK may, like their African counterparts, withdraw from school, especially as they reach puberty. We’re not yet sure to what extent, but psychological problems may arise; confidence may be eroded; and in any case the intention of FGM is to prepare a girl for marriage and dependency on a husband, often all too soon.

All this means that young women with FGM in western diasporas may experience the sort of alienation from mainstream society which, in traditional practising countries, that same inflicted damage is specifically intended to avoid.

Further, newly established communities in which members of the diaspora live may become even more marginalised if, through FGM, some young women cannot engage profitably with their host societies. Alienation doesn’t always happen, but to date we don’t know why it may or may not occur.

Nor do we properly understand the wider economic drivers of this personal, preventable tragedy and enormous public health challenge. If political leaders across the globe understood this, perhaps they would take greater cognisance of valiant researchers and activists who work in very difficult circumstances on the ground to eradicate FGM.

And just as the eons-old genital mutilation of girls and women continues to be big business, so too now is the ‘FGM eradication’ global industry, absorbing talent and resources also sorely needed elsewhere. The opportunity costs of FGM are huge.

As Dr. Gebreselassie Okubagzhi of the World Bank Group insisted at the UNFPA Global Consultation on FGM (Addis Ababa, 2007),

..an analytic study [of FGM] to compile data on economic cost implications is critical… for launching effective community and international advocacy.

Money talks. Sadly, it’s often more persuasive than moralising. Choosing education and economic autonomy, not mutilation and inopportune marriage, must be put within the grasp of every girl.

As much in the UK as anywhere else, it’s time to become strategic, to recognise overtly (and politically) how these economic imperatives impinge on wider private and public resources, and on the futures of vulnerable girls everywhere.

It must also be asked, given the huge human and hidden fiscal costs of not addressing FGM in the developing world, should UK Aid be conditional, in those countries most affected, on solid evidence that FGM is being tackled by the domestic authorities?

It would take careful diplomacy to achieve a positive outcome with this approach – hackles can rise easily – but the idea that international donors of aid should tie this to the eradication of FGM is not new. Here’s the view of Efua Dorkenoo, writing in her book, Cutting the rose, in 1994 (p.174):

‘Aid donors have a right and duty to become involved in [FGM] prevention and to place pressure on the relevant governments to undertake effective measures to eradicate it.
‘In areas where more than 50% of the female population undergo genital mutilation, [thereby] placing extra burdens on already inadequately resourced health care and delivery, aid given towards health programmes should be tied to proven measures taken by governments to abolish female genital mutilation.’

Demanding an end to FGM would hit several universal targets, including health, efficient use of funds, and human rights. It could in the short term, despite the challenges, be more feasibly achieved by developing world national governments than putting an effective stop to corruption or recouping lost tax. Has anyone done the metrics?

No longer can we indulge our ignorance of the hard economics underpinning FGM.

This article concerns approaches to the eradication specifically of FGM. I am also categorically opposed to MGM, but that is not the focus of this particular piece.

Anyone wishing to offer additional comment on more general considerations around infant and juvenile genital mutilation is asked please to do so on the relevant dedicated thread, originally developed in June 2012:

Dear Hilary, thanks for this article and your clear statements! It is true, “money talks” and yet, the economic aspect is still neglected in the development of strategies to end FGM, especially on governmental level. Sadly, the lack of political willingness could be better tackled through economic than Human Rights arguments.
In addition to your reasoning I would like to add the economic loss for the practicing society – girls who won’t get education according to their competences, women who will not get into the labor market, and so forth – there must be a loss for the GNP. Well, and there are the donating countries and organizations who finance the fight against FGM with how many million €/£/$ by now? This fight created a labor market in its own: the NGOs where people get paid for their work as long as it takes… I dare asking: do they still give 100% to end FGM as fast as possible?
The analytic study on the economic impact of FGM is still missing and I am glad that through our organization’s efforts at least a first systematic review on this issue is on it’s way.
Keep up your excellent work, Hilary, and all the best for it!
Holger Postulart

Thanks very much, Holger…. and yes, I do very fully agree about the other economic losses! It’s such a tragedy that so many human and other resources, and so much money which could be well spent, is squandered because of such a cruel tradition.